ABSTRACT: OBJECTIVE: The ambulatory clinic was an important departmental
problem. Providers hated working there and patients complained about the wait
times there. It seemed there were equal numbers of patients and provider
complaints. In the spirit of solving the problem, data was gathered, a LEAN
intervention was planned, and data was collected. METHODS: We defined
the service families in the clinic as registration, vital signs, provider or
ultrasound visit, nursing visit, and registration for the return visit. We
walked the Gemba engaging all the staff in the process. Many observations
pointed to long waits between and among the five stations. In order to study
the current state, time data was collected by attaching a sheet of paper to a
folder that the patient would carry themselves to all the clinical steps. On
the sheet of paper each station logged the time that patient appeared and the
time the patient left their sight. Data was gathered each day and every day
from October 2016 to the summer of 2017. The data was analyzed. Leadership met
and identified value and waste in the process. A Kaizen event was scheduled
after the first set of measurements engaging all the staff. After the data was
thoroughly analyzed and digested, brainstorming occurred. Together we
determined our future state. We created a vision and strategic goals to reach
our future state. RESULTS: The data pre-Kaizen event showed that the
process of arrival to leaving took 124 minutes. We discovered that not every
patient passed through each station. We learned the patients were on time or
early for their visit most of the time. The providers were late most of the
time by 1 - 1.5 hours. We learned how long each station took
from the patient’s point of view. There were no statistically significant
differences between ultrasound and provider visits; there were no statistically
significant differences between midwife and physician visits. Each day of the
week was similar. The arrival rate was higher in the morning because of the
template. After the event, the total time in clinic did not change however the
variability in time between and among each station decreased in variance. We
informed the staff of these findings so that they could take responsibility for
their part in the process. The atmosphere in clinic changed dramatically and
the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results,
got the staff engaged in the process, and provided a way for the patients to
see the efforts made by staff to improve.